Transfemoral access is the traditional gold standard for uterine artery angiography; however, transradial access is gaining in popularity because of its decreased complication profile and patient ...preference. We present a case of a patient who underwent successful total abdominal hysterectomy for symptomatic uterine fibroids with ambiguous pelvic vasculature that would have been otherwise aborted if it were not for intraoperative transradial access angiography.
A 52-year-old Caucasian woman presented to her gynecologist for an elective total abdominal hysterectomy and bilateral salpingo-oophorectomy. During preoperative imaging, a 15-cm mass consistent with a uterine fibroid was identified, and the patient's gynecologist decided to treat her with surgical resection, given the fibroid's size. The procedure was halted upon discovery of a complicated vascular plexus at the fundus of the uterus, and an intraoperative vascular consult was requested. The vascular operator used a transradial access to perform pelvic angiography in real time to identify the complicated pelvic vasculature, which allowed the gynecologist to surgically resect the uterine fibroid. The patient was discharged on postoperative day 4 without any complications.
Intraoperative imaging is a useful technique for the identification of complicated anatomical structures during surgical procedures. The successful outcome of this case demonstrates an additional unique benefit of transradial access and highlights an opportunity for interdisciplinary collaboration for management of complicated surgical interventions.
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•Extensive U–Pb detrital zircon dating in Dobrogea area.•Analysis of U–Pb age distribution patterns for each sample and for each terrane.•Crustal fragments from Dobrogea area has ...peri-Gondwanan, peri-Amazonian provenance.•Rethinking of TESZ placement on the Romanian territory.
The Romanian South Carpathians foreland is located southwards of the East European Craton (EEC) and consists of three major tectonic units: the Scythian Platform, the North Dobrogean Orogen and the Euxinic Craton. The Euxinic Craton is represented in the Dobrogea area by two components: (i) Central Dobrogean Shield and (ii) East Moesia. In central-northern Dobrogea, the Trans European Suture Zone (TESZ), including the Teisseyre–Tornquist Zone, presumably strikes below the surface. Because the paleogeographic provenance of the above tectonic units was poorly documented until present, a systematic sampling for detrital zircon has been conducted in all tectonic units except for the Scythian Platform basement which is entirely covered by the Danube Delta. In all, this totals 26 samples and around 1833 analyzed zircon grains. The distribution of zircon grains dates along the time scale for all the sampled terranes suggests that the sampled components of the Euxinic Craton in Dobrogea and the constitutive terranes of the North Dobrogean Orogen have a peri-Gondwanan, peri-Amazonian provenance. Their ages are Neoproterozoic or younger. In addition, the Euxinic Craton can be depicted as a paleo-Amazonian crustal fragment that was marginally affected by the Avalonian–Cadomian orogenic events. Along with its margin, the Avalonian type terranes accreted or Ganderian type terranes have evolved. Primary relationships between the Amazonian derived terranes and EEC are obscured due to an intricate geologic history exhibited by the North Dobrogean Orogen involving Caledonian, Variscan and Cimmerian orogenic events, while the geologic history of the Scythian Platform is also poorly established. The general distribution diagram of U–Pb detrital zircon ages shows some major zircon sources, shared with those detected at a global scale. They are episodic and coincident along with the time scale, such as those at the end of Archean or those from the Pan-African orogens. Finally, among these discussed tectonic components, only the Scythian Platform can possibly have an EEC provenance.
To create a system where evidence based medicine can be applied to accommodate every woman's needs by designing a contraceptive pathway that can be utilized by any healthcare provider, regardless of ...the patient's age, and to offer appropriate counseling in order to maximize patient outcomes, especially for the midlife woman.
United States Medical Eligibility Criteria for Contraceptive Use, 2016 (US MEC) was used as the framework for these recommendations for a contraceptive care pathway that can be incorporated into care for midlife women.
By utilizing a total office approach that includes the scheduler, receptionist, medical assistant, nurse and health care provider as members of a team, the entire spectrum of the patient population in need of contraception from teenagers to midlife can be captured. Specifically for midlife women the need for an effective form of contraception may be overlooked as fecundity declines in this age group. This paper will highlight the use of this pathway for midlife women.
From 2011 to 2015, a total of 67 patients were referred for IUD insertion guided with transabdominal sonography (TAS). Fifty‐six of the 67 patients had successful IUD insertion under TAS guidance. ...The clinical indications for referral included fibroids, uterine position, previous history of IUD expulsion, and limited tolerance of pelvic examination. Reasons for failed TAS‐guided IUD insertion included patient discomfort, cervical stenosis, and inability to remove and replace an existing device. Ultrasound guidance could help broaden the patient population that may benefit from the therapeutic value of an IUD.
•A global survey of age – chemistry of zircons shows similar features of granitic magmatism over time.•Changes in temperature and chemistry do exist over time in the global database.•3.2 Ga is a ...moment of great change in continental evolution.•A Neoproterozoic spike in crustal thickness and metamorphism is notable in the database.
Temporal trends in granitoid chemistry and thermometry constrain major global changes in magmatism, tectonism or crustal thickness in the continents. Our study relies on zircon geochronology and trace element geochemistry on four new detrital rocks (two modern sediments and two Archean metasedimentary rocks) and a global compilation of published single zircon detrital chronology and trace chemistry data acquired on 5587 individual grains. Zircons of all ages from 4.4 Ga to present exist in this archive. Ti-in-zircon thermometry indicates that more than 98% of the grains with concordant U-Pb ages formed at temperatures exceeding 650°C. The great majority of these zircons formed in the 650–850°C range consistent with growth in intermediate to silicic magmas. Magmatic temperatures increased over time for the first 1.2 Ga of Earth's history after which they stayed constant before decreasing during the more recent past. U/Th<5 values in the overwhelming majority of grains are consistent with a magmatic origin. La/Yb, Sm/Yb and Eu/Eu* values are relatively constant throughout the history of the Earth suggesting that most granitoids formed at, or evolved from magmatic reservoirs located at depths of 35–45 km in the presence of amphibole, garnet and limited plagioclase. Such reservoirs are common today in hot deep crustal environments beneath some of the thicker island arcs and all continental arcs along subduction zones. Processes other than modern day style subduction may have contributed to the formation of granitoids in the early Earth but temperatures, depths and the presence of water arbitrated by the presence of amphibole were similar. These results also suggest that the thickness of continental crust in areas that produced granitoids was similar to today's global average throughout the 4.4 Ga time period covered by the zircon archive. There is no correlation between zircon chemistry over time and the assembly of supercontinents.
The Danubian domain basement of the South Carpathians, Romania, comprises two Neoproterozoic continental crustal fragments, the Drăgşan and Lainici-Păiuş terranes, which were sutured by the closure ...of an intervening oceanic domain, the Tişoviţa terrane. Magmatic and detrital zircons extracted from an orthogneiss, four granitoid plutons, two metasedimentary units, and a Liassic sandstone were dated by zircon U/Pb LA-ICP-MS. The Făgeţel augen gneiss from the Drăgşan terrane basement yielded an age of 803.2
±
4.4
Ma, the oldest well-constrained crystallization age reported from the Romanian Carpathians basement. The Tismana, Şuşiţa, Novaci and Olteţ granitoid plutons, which intrude the Lainici-Păiuş terrane basement, yielded ages of 600.5
±
4.4, 591.0
±
3.5, 592.7
±
4.9, and 588
±
2.9
Ma, respectively. The Tismana granitoid age of 600
Ma and the youngest detrital zircon ages of 637–622
Ma from a metaquartzite within the Lainici-Paiuş terrane, constrain the deposition of the metaquartzite protolith to ca. 620–600
Ma. The 803
Ma age represents an old Pan-African age, whereas the younger Neoproterozoic ages suggest Pan-African/Cadomian thermotectonic events. Detrital and inherited zircon ages within the Drăgşan and Lainici-Paiuş terranes attest to a peri-Amazonian, Avalonian-type provenance for the Drăgşan terrane and possibly a Ganderian-type provenance for the Lainici-Păiuş terrane. The Lainici-Păiuş terrane rifted off Gondwana before the Drăgşan terrane. Both terranes were attached to Moesia during the Early Paleozoic.
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► The Danubian terranes are Avalonian fragments sutured to West Moesia during the Late Ordovician. ► Lainici-Păiuş terrane was subjected to extensive granitoid plutonism at 600–590
Ma. ► It originated in the active margin of a post-Rodinian continental fragment.. ► Făgeţel gneiss is the oldest igneous protolith in the Romanian Carpathians proved by zircon dating. ► During the Variscan Orogeny, the Danubian domain basement was subjected to granitic plutonism.
The basement of the Romanian Carpathians is comprised of pre-Variscan metasedimentary and metaigneous units. Age patterns from corresponding detrital zircons show similarities to those from the ...eastern Mediterranean region. Consistently, these patterns suggest a northern Gondwanan origin for the Carpathian terranes with the most common detrital sources representing fragments of the Pan-African Orogen, Arabian-Nubian Shield, Kibaran Orogen, and West African Craton (Eburnean Orogen and Liberian-Leonian Orogens), as well as the Saharan metacraton. Some contributions from the Indian Craton are also possible. The youngest detrital zircon ages constrain the maximum age of the sedimentary rock protoliths to Middle Cambrian. On the other hand, the U/Pb zircon ages of the metaigneous protoliths indicate predominantly Early Ordovician ages and bracket most magmatism in the Carpathian pre-Variscan basement units between Middle Cambrian and Late Ordovician. An exception is the Neoproterozoic lower part of the Sebes–Lotru terrane, whose igneous ages are equivalent to the Danubian Domain in the South Carpathians. The Carpathian pre-Variscan terranes were originally located along the eastern extension of the Galatian superterrane, and thus within a Late Cambrian to Ordovician extensional tectonic setting.
The Sebeş–Lotru terrane in the South Carpathians mountain range comprises a lower, Neoproterozoic metamorphic unit (Lotru) and an upper, Ordovician metamorphic unit (Cumpăna) that were juxtaposed ...during the Variscan orogeny. Two orthogneisses from the Lotru metamorphic unit yield U/Pb LA-ICP-MS zircon crystallization ages of 549.3
±
3.8
Ma and 587.5
±
3
Ma, respectively. Two orthogneisses from the Cumpăna metamorphic unit yield zircon crystallization ages of 458.9
±
3.5
Ma and 466.0
±
4.2
Ma, respectively. High U zircons from two other orthogneisses from the Cumpăna metamorphic unit have ages ranging from 400
Ma to 320
Ma, which are interpreted to reflect protracted zircon recrystallization during the regionally significant Variscan collisional event. Detrital zircons from a metasedimentary gneiss in the Cumpăna metamorphic unit have ages ranging from ~
0.5
Ga to 2.8
Ga. The 0.5
Ga age constrains the maximum sediment deposition age to be late Cambrian. The source most compatible with the range of Precambrian detrital ages in the Sebeş–Lotru terrane is northeastern Gondwana.
The Sebeş–Lotru terrane was part of a continental subduction/collision system as a lower plate after about 400
Ma and reached peak metamorphic conditions between 350 and 320
Ma (e.g. Medaris et al., 2003). A cross-cutting granite vein has a zircon U–Pb crystallization age of 321.5
±
3.1
Ma, which constrains minimum age of ductile deformation during the Variscan collision in this region. The trace of the Rheic suture within the South Carpathians is located between the Ordovician upper part of the Sebeş–Lotru terrane and the Drăgşan pre-Alpine terrane of the Danubian domain.
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